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Coming dissertations at MedFak

  • Forensic taphonomy in an indoor setting : Implications for estimation of the post-mortem interval Author: Ann-Sofie Ceciliason Link: Publication date: 2020-10-02 09:20

    The overall aim of this thesis was to determine if and how taphonomic data can be used to expand our knowledge concerning the decompositional process in an indoor setting, as well as adapting scoring-based methods for quantification of human decomposition, to increase the precision of post-mortem interval (PMI) estimates.

    In the first paper, the established methods of Total Body Score (TBS) and Accumulated Degree-Days (ADD) were investigated in an indoor setting, with results indicating a fairly low precision. The PMI was often underestimated in cases with desiccation and overestimated in cases with presence of insect activity. This suggests that the TBS method needs to be slightly modified to better reflect the indoor decompositional process.

    In the second paper, a novel method for PMI estimation was developed using histological assessment of decompositional changes in the human liver. The scoring-based method created, the Hepatic Decomposition Score, was a statistically robust way to quantify the degree of decomposition, with the potential to improve the precision of PMI estimates.

    In the third paper, the indoor decomposition process was further investigated regarding microbial neoformation of volatiles in relation to the degree of decomposition and the PMI. A higher decomposition degree was observed in cases with neoformation (i.e., presence of N-propanol and/or 1-butanol in femoral vein blood) than in cases without signs of neoformation. Microbial neoformation may be an indicator of decomposition rate, which may make it possible to improve the precision of PMI estimates based on the TBS/ADD method.

    In the fourth paper, a novel constructed Bayesian framework allowed a qualified estimate of PMI based on observed taphonomic findings. This framework provided a unique possibility to report results, express the uncertainties in assumptions and calculations, as well as to evaluate competing hypotheses regarding PMI periods or time of death.

    Taken as a whole, the results indicate that using taphonomic data derived from an indoor setting could improve scoring-based methods, as well as highlighting benefits of incorporating such data into a Bayesian framework for interpretational purposes and for reporting PMI estimates.

  • Aspects on Mechanisms, Treatment and Outcome in Severe Traumatic Brain Injury Author: Teodor Svedung Wettervik Link: Publication date: 2020-10-02 08:28

    Traumatic brain injury (TBI) is a leading cause for mortality and morbidity worldwide. The primary injury has great impact on patient outcome and cannot be cured, but attentive neurointensive care (NIC) may reduce detrimental secondary brain injuries and is the focus of this thesis.

    Some patients with severe TBI develop dangerously high intracranial pressure (ICP). In paper I, we found that decompressive craniectomy was an efficient last-tier treatment of intracranial hypertension in an escalated management protocol also including barbiturates. Furthermore, the cerebral perfusion pressure (CPP) is a treatment target in TBI to avoid cerebral hypo-/hyperperfusion, but it does not take into account the cerebral blood flow (CBF) pressure autoregulatory status. In paper II, we found that intact CBF pressure autoregulation, particularly day 2 to 5, was significantly associated with favorable outcome and that keeping the absolute CPP close to autoregulatory (CPPopt)- rather than fixed CPP-thresholds correlated more strongly with favorable outcome. In paper III, ICP variability was found to be a predictor of favorable outcome, possibly as it partly reflects better regulation of CBF. TBI treatments ultimately aim to optimize cerebral energy metabolism. In paper IV and V, two physiological variables were separately evaluated in relation to cerebral energy metabolism in TBI, monitored with a microdialysis in the brain. In paper IV, mild hyperventilation (pCO2 4.0-4.5 kPa), a therapy to reduce ICP by cerebral vasoconstriction, was found to be more commonly employed when ICP was high, but tended to improve the CBF pressure autoregulation. There was no association between mild hyperventilation and worse cerebral energy metabolism, indicating that this level was safe and did not induce cerebral ischemia. In paper V, higher arterial glucose was associated with worse CBF pressure autoregulation, cerebral energy metabolic disturbances and worse clinical outcome. This indicates that arterial hyperglycemia could induce secondary brain injuries in TBI.

    Today, TBI patients are treated according to “one size fits all”-protocols. However, with better understanding of the pathophysiological mechanisms and the effects of TBI treatments by means of multimodality monitoring, we will be able to earlier detect and diagnose different pathological processes and evaluate the effects of treatments. This will help us give more individualized care to reduce secondary brain injuries and improve outcome for these patients.

  • Exposed to Violence Author: Mariella Öberg Link: Publication date: 2020-09-24 10:24

    Violence against women is a crime against human rights and a major global public health issue affecting the lives of millions of girls and women worldwide. Exposure to violence poses a threat to health, both in the short and the long term. To minimize the devastating consequences of violence it is central to identify girls and women who have been exposed and to find possible risk factors that may serve as targets for prevention efforts.

    The main aims of this thesis were to study the prevalence of sexual, physical and psychological violence among women in Sweden and to explore possible associations to violence and polyvictimization during childhood as well as sociodemographic factors.

    In a family planning unit, 1226 women seeking either termination of pregnancy or contraceptive counseling were recruited to answer questions about different types of violence. Of the women seeking termination of pregnancy, 29% reported experiences of intimate partner violence, compared to 22% of women seeking contraceptive counseling. Of all the women attending a family planning unit, 27% reported lifetime experiences of sexual violence.

    A survey containing questions about lifetime experiences of sexual, physical and/or psychological violence was sent to a national sample of 10 000 women and 10 000 men. Lifetime experiences of at least one type of severe violence were reported by over 50% of both women and men. Sexual violence was more than three times more common among women compared to men.

    Rape/attempted rape in adulthood was more common among women who were single, had college-level education and those who had been unemployed or had received social welfare payments.

    Exposure to sexual, physical and psychological violence in childhood was highly associated with rape/attempted rape in adulthood among the women respondents.

    Conclusion: Lifetime experiences of violence are common among women in Sweden. Multiple exposure to violence during childhood is the most potent risk factor for exposure to sexual violence in adulthood. The findings underscore the importance of detecting individuals who have been exposed in order to offer help, and may contribute to the development of effective prevention programs, especially among children and adolescents.